Coma vs.

Brain Death
Patients who suffer brain death are not in coma. Patients in coma may or may not progress to brain
death.
The brain is a very complex organ. It is the brain that controls not only an individual's thought process
and voluntary movements, but it controls involuntary movements and other vital body functions. These
functions include auditory, olfactory, visual and tactile senses, regulation of body temperature, blood
pressure, respiration, and heart rate (although the heart can continue to beat without the brain in
"autotonic response"). The brain also produces hormones to control individual organ function. A good
example is the brain's production of anti-diuretic hormone (ADH). This hormone is produced to
concentrate the urine in thekidneys, thus protecting against life-threatening dehydration.
Patients in coma may be in deep coma or may survive in what is termed a "vegetative state." The
difference between these two groups is that a deep coma patient usually requires hospital care, while
a patient in a vegetative state may be released to the family for home care. The individual in the
vegetative state has a lot more lower-brain function, and a bit more upper brain-stem function, than a
patient in deep coma.
In either case, the patient is considered legally alive. Patients who are in coma will have some
neurological signs. The amount of brain activity is variable, and extensive clinical examinations are
performed on these patients. The physician(s) observes the patient for any sign of electrical impulse
leaving the brain as a result of an external stimulus. Patients in coma will have these signs; patients
who suffer brain death will not.

How brain dead work??

Many recent advancements in modern medicine and breakthroughs in the understanding of human
physiology have made it possible to separately and artificially maintain tissue viability without the
impulses being transmitted by the brainor brain stem.
Due to the continual medical advancements, there will be more and more patients who are being
maintained by ventilation support systems -- their body temperature, blood pressure, pulse, nutrition
and fluid requirements are being artificially maintained, but they have a non-viable (dead) brain.
These patients are brain dead without any hope of recovery or survival.
In this article, you'll learn about the diagnosis of "brain death" and how it compares with coma and
cardiac death.
Nothing in this article should be construed as a treatment regimen or suggested treatment regimen for
any particular patient. All patients with neurological injury and the next of kin of the patient should rely
on their local neurosurgeon or neurologist for the best care plan for the patient.

The Injured Brain

When the brain is injured, whether by natural causes or trauma, there are three possible results:
bleeding, swelling, or both. Causes for damage to the brain that may result in "brain death" include:

Trauma

Open (Gun shot wounds, etc)

Closed (Blunt injury, etc)

Anoxia (a period of no oxygen caused by drowning, hanging, smoke inhalation,carbon-monoxide
poisoning, etc.)
Cerebral vascular accident

Stroke (emboli blocking arteries feeding the brain)

Ruptured aneurysm

Infection (Bacterial, Viral, Fungal)

Tumor

Non-metastasis

Metastasis
Drug overdose

Low blood-glucose levels

Bleeding in the brain can be catastrophic. Neurosurgeons can open the skull and try to control the
bleeding. When the brain starts to swell, the ventricles collapse and the pressure within the skull starts
to increase. The increasing intercranial pressure (ICP) must be treated or else major neurological
problems occur. The physician will give the patient anti-inflammatory medications, high osmolar
medication to reduce swelling and try to provide highly oxygenated blood, so any blood getting into
the brain will produce the maximum benefit.
Even with everything being done to reduce bleeding and cellular swelling, the treatment may not be
enough to control the ICP. As the ICP increases, there is nowhere for the swelling tissue to go
because of the restrictions provided by the bony skull. Sometimes, the neurosurgeon will place
a bolt into the skull. The bolt is screwed into the skull and has a hole in the middle, connected to a
tube, which is used to remove some intercranial fluid, allowing for swelling and a way to measure the
ICP.
If the ICP cannot be controlled, the pressure will continue until the ICP is the same as the patient's
blood pressure. At this time, no blood will enter the brain, and the brain dies. In many cases, the
pressure will increase to a point that the pressure will push the brain stem down into the spinal
column. This is calledbrain herniation, and it results in instantaneous brain death.